Where kids are is not where care is—and that gap is widening

There is a fundamental misalignment at the heart of pediatric healthcare in America: The children who most need specialized care do not live where that care exists. And as cell and gene therapies transform what is possible for kids with complex conditions, the distance between a child's zip code and the nearest children's hospital has never mattered more.

Access isn’t just one problem

The most transformative therapies in healthcare history are here. The infrastructure to deliver them isn't.

Access to breakthrough cell and gene therapies isn't a single gap—it's five compounding failures arriving at once: subspecialty workforce shortages, consolidating pediatric hospital capacity, geographic misalignment between facilities and patient populations, institutional infrastructure that confines advanced therapies to academic medical centers and children’s hospitals, and patients who don't know these options exist.

The programs that improve access to these critical therapies don't just win competitively. They deliver on the actual promise of innovation—turning clinical breakthroughs into lived reality for the patients who need them most.

Access is no longer merely a patient experience metric. It's the strategic variable that determines who leads the next era of care delivery.

Care doesn’t follow the population

Across the United States, approximately 220 children's hospitals operate with roughly 35,000 total beds—a national average of just 49 beds per 100,000 pediatric population. That number conceals enormous geographic inequity. Children's hospitals are concentrated along the coasts and urban centers, while large pediatric populations live in the interior of the country. It also means the potential of overcapacity for states with a high number of children’s hospitals and underutilization elsewhere. In addition, a few states have a low density of pediatric beds resulting in a consolidation to large urban children’s hospitals causing a thinning of facilities in rural areas. For a family whose child needs acute, specialized care, geography becomes a clinical variable impacting time, travel and potential care giver dilemmas. There is also a financial impact, such as accommodations for extended time periods, child care for siblings and time away from employment.

The misalignment is worsening. Declining birth rates contribute to reduced numbers of pediatric care offerings at acute care hospitals, further accelerating concentration of pediatric care at large regional centers. Pediatric inpatient units are closing and being repurposed for adult care—as evidenced recently at Tufts Medical Center on the northeast coast where pediatric beds were converted to adult use. Workforce shortages add to the strain. In 2026, only 78% of pediatric physician subspecialty fellowship positions were filled. With compensation in many adult specialties far outpacing that of pediatric subspecialties, recruitment and retention remain ongoing challenges. The result is a smaller specialist workforce, fewer local access points, and longer journeys for families seeking care.

Figure 1. Where kids are is not where care is–and that gap is widening

Sources: Children’s Hospital Association. Directory. Accessed May 2025; Claritas Pop-Facts®, 2024; Analysis, 2025

When strategy meets access

For health system leaders, three priorities are clear. First, the need to build support systems for complex patients through partnerships of elite institutions providing cutting edge therapies with community providers to provide day-to-day supportive care. Second, communication with extended markets to ensure patients are aware of what treatments are available for them. Third, development of administrative teams to support patients and programs delivering this care from beginning to end - knowing that costs to the patient and the hospital can be quite high.

The prospects are clear. The data is available. Health system leaders who move decisively now will define what equitable, high-performance pediatric care looks like for years to come.

Data and analysis sourced from 2025 Symposium on Oncology, Pediatrics & Cell and Gene Therapy Trends, including Impact of Change® forecasts, National Consumer Survey 2025, the Children's Hospital Association Directory, and Claritas Pop-Facts® 2024/2025.